NITRIC-OXIDE SYNTHASE DISTRIBUTION IN THE ENTERIC NERVOUS-SYSTEM OF CHILDREN WITH CARDIAC ACHALASIA

Objective To study the distribution of nitric oxide synthase (NOS) in the enteric nervous system of children with cardiac achalasia. Methods Biopsy specimens of the lower esophagus, cardia, gastric fundus and p ylorus from 13 patients with cardiac achalasia and 6 controls were obt ained and studied histochemically with nicotinamide adenine dinucleoti de phosphate diaphorase (NADPH-d) and immunohistochemically with a spe cific polyclonal antiserum. Results NOS was abundant ill the myenteric plexus and the nerve fibers of musculatures in the esophagus, cardia and gastric fundus in control group, while it was nearly absent in the patient group. The distribution of NOS in the pylorus was similar in the two groups. Conclusion These findings suggest that a lack of NOS i n the lower esophagus, cardia and gastric fundus is involved in the pa thophysiology of cardiac achalasia in children.